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What is the Westley Croup Score?

Patient Presentation A 3-year-old male came to clinic with a history of a barky, seal-like cough the previous night.
He had had some rhinorrhea for 2 days but was afebrile. He had awoken with the cough and tachypnea.
His parents took him into the bathroom and used a humidifier and shower mist with good results.
He went back to sleep and was well in the morning, drinking and eating normally but with a coarse voice.
The pertinent physical exam showed normal vital signs and growth parameters including a respiratory rate of 21.
HEENT showed clear rhinorrhea, mild fluid in the left ear without other pathology, and a few pinpoint palatal vesicles.
Lungs were clear.

The diagnosis of croup was made. The physician discussed the possibility of using dexamethasone with the family. After talking about the potential dexamathason benefits and limitations of the available research, the family chose to not use it.
Followup showed that the illness resolved without problems.

DiscussionCroup or acute tracheolaryngobronchitis is a common, self-limited disease caused by common respiratory pathogens especially Human Parainfluenza virus.
It can occur year round but often comes in waves particularly in fall, winter and early spring. Three percent of <6 year old children acquire it yearly with less than 5% of these requiring hospitlization. Of the hospitalized children, 1-2% require intubation.
Most children have mild symptoms (defined as a barky cough, no audible stridor at rest and no or mild retractions of the chest wall).
Often symptoms are worse at night and better during the day, and duration of symptoms generally last a few days.

Treatment for croup has included:

Humdified air – many parents are instructed to create a steambath in a bathroom (with care so family is not burned by hot water), use a humidifier or take the child into the cool night air.
Clinical trials have not supported this use in some studies, but many clinicians have had experiences which do support its use.

Racemic epinephrine – can be helpful in moderate or severe croup and its onset of improvement is often within 10-30 minutes, but efficacy usually decreases within a couple hours. Most children did not have worse symptoms after treatment than they had had before treatment.

Heliox – data is equivocal for its use.

Glucocorticoid medication – use of glucocorticord has been show to reduce hospital admission, decease stays in the emergency room and hospital and decrease other supplemental medication.
There is data that supports smaller doses of dexamethasone (0.15 mg/kg instead of standard 0.6 mg/kg) and that dexamethasone has a faster onset of action (30 minutes) than standardly believed (4+ hours).

Learning Point
Studies of croup often use the Westley Croup Score as a standard measurement of croup severity shown below.

Patient Care
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.

Medical Knowledge
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

Practice Based Learning and Improvement
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.

Systems Based Practice
23. Differing types of medical practice and delivery systems including methods of controlling health care costs and allocating resources are known.
24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.

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The information contained in PediatricEducation.org is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.